My very first patient had malaria. It turns out, he went on a mission trip to Africa, forgot to take his malaria prophylaxis, and subsequently got malaria. It was so interesting to see what his disease course looked like in contrast to the children I have seen in orphanages in Africa with the same disease. What a great way to start the rotation!
I was excited to learn about HIV/AIDS. I told the fellow this, and he gave me a patient about half way through our first week that I followed pretty much the whole rotation. I got to learn more about what his specific HAART drugs were, and watch what we ended up switching the drugs to and why. I also got to research more about what we diagnosed him with, and how the treatment differs for someone with AIDS. We were very involved in his care. Watching him ender respiratory failure, get moved to the ICU, lose all ability to communicate with the outside world, and then recover helped me see a little more about the deep struggles and immense hope you have to think about when you deal with an illness like AIDS. I also learned a lot more about tailoring drugs for renal failure and drug side effects.
I learned more about antibiotics (the best drugs for specific diseases) and how to look up new guidelines in the Sanford guide. I used that book a lot! I also got to listen to an ID conference on the growing amount of antibiotic resistance, which was fascinating! I think in the future we’ll have to worry about that a lot more than people do now, so it was great to see that there is research about what works, what doesn’t, and what we can try next.
I was surprised at how good I got at thinking like someone in ID. I got great at creating a plan and making recommendations to the teams, especially about things we talked about a lot: narrowing drug spectrums and picking a reasonable treatment length.
I liked being on a consult service and being the person primary teams came to with questions. We were much more involved in care than I thought we would be!
I honestly wish we had gotten to see more diverse cases and gotten more teaching from our attending doctors. The service was set up so that we had a new attending all the time, and I feel like that made each attending feel less responsible for teaching us. It took me a long time to get comfortable with antibiotics and antiretrovirals, most of my learning was on my own which I don’t think is as effective as learning by caring for a patient. I think the rotation was good because everyone will be exposed to infectious diseases no matter what practice they are in, but I wish it was set up differently. It would have been neat to spend time at the Dallas County Health Department to see TB treatment or STD treatment, or to be at Amelia Court to see more AIDS treatment and care.
Overall, I learned a lot, but I don’t think I’ll want a job working on an ID consult team at a hospital!